The presentation went very well. I had a mere 20 mins to present but discussion continued for another 20. Two MD's have expressed an interest in implementing a similar model and we will hopefully be in touch.

I would like to share some thoughts about what it's like to be a librarian attending a non- librarian conference. The problem is that I have never been to a library conference so I don't have any basis for comparison. I can't say whether certain aspects of my experience are unique to me, to this particular conference, whether they are unique to medical conferences, or whether they apply to conferences in general. Perhaps I will hold off on trying to analyse my experience on any profound level until I have attended an actual library conference.

I will say that I met and spoke with many interesting people, particularly at the poster sessions where I was able to chat with the representative from UptoDate who told me that librarians are their toughest critics, and with several people from the Mayo Clinic whowork in the area of patient education and were surprisingly modest about their work, and the incredible resources they have at their disposal.

What was missing to some degree was the urge to connect again in future, which I suspect would have been there had we been professional colleagues. In general my impression is that librarians are respected for the work they do, it is recognized that much of what we do overlaps and even sometimes duplicates the work of health care workers in the area of consumer health education, and our resources are being used with enthusiasm. But we are nonetheless justifiably considered separate entities from the health care team. This model (perception? habit? philosophy?) is of course what I am working to change at my own clinic, for the most part successfully.

If teams are to be truly multi and interdisciplinary, then it stands to reason (at least to my mind) that they should include members of any profession who brings added value to the care the team provides. In order for this to happen, more of my professional colleagues will need to enter the trenches (this is a challenge in every sense of the word).

The question is: why is this so important?

The first and most important reason in my mind is that of trust. This is something I got to thinking about when I was preparing my presentation. It was of course necessary for me to answer the question: why in house? There were several reasons (the library is far, the health professionals need support too, the librarian is better placed to understand the needs of the community) but the one that resonated most, for myself and for my audience, was trust. Trust can come into the equation in several important ways:

The health professional may be more likely to trust the librarian to provide health information to his or her patient if the consult is treated as a clinical encounter and documented in the chart.

The patient or family member may be more likely to trust the librarian to provide health information if their doctor or nurse has referred them to a service which is down the hall from the exam room.

Perhaps most importantly: the patient or family member may be more likely to trust that their doctor or nurse wants them to be informed and is willing to discuss the information they are accessing, if the information is being provided by a member of the health care team. The message then is this: we want you to be empowered, we support shared decision making.

*My apologies for not posting last week. I was hoping to be able to publish a post from the conference but at $4 per 15 mins of Internet time it didn't end up being reasonable.

About Info.Rx

Update:

In the fall of 2008 a Clinical Medical Librarianship component was added to the service. The librarian now acts as a resident supervisor in the teaching rooms at the clinic one half-day per week, providing support for clinical decision-making in addition to continued support for patient education.

The service is based on an innovative InformationRx model first implemented in the UK (see: Early experience of thecontribution of an information specialist within a primaryhealthcare team: a partnership venture betweenlibrary and healthcare services, doi: 10.1177/0961000604048915].

This model sees the information professional acting as a member of the health care team by providing informational/instructional support for patients/families and health professionals at point of care. Support for the service is provided by the main hospital library and is vital for ensuring long term sustainability.

The information professional is available 7 hrs per week to consult with patients/families that are in need of health information.

Health staff are encouraged to write InformationRx for patients which can then be filled by the information professional. Consultations with patients are treated as clinical encounters and are documented in the charts. The service has a clinic in the Centre's appointment scheduling software.

Patients and family members are welcome to drop in, or to submit questions by phone or email at their convenience. They can schedule appointments by contacting the information professional directly or by calling their team coordinator.

The library provides support by welcoming questions from patients and their families when the coordinator is not available. Herzl patients and families are able to borrow books from the Patient and Family Resource Centre's (PFRC) print collection, and a family medicine section has been created on the PFRC website which provides links to reliable and up-to-date consumer health resources.

Author"s note

Important: While based on real consultations, the cases posted in this blog have been mashed up, fictionalized, posted out of sequence, and otherwise tinkered with in order to maintain the privacy and comfort of the parties involved.

Also, the views and opinions expressed in this blog are strictly my own and do not necessarily reflect those of my employers.

About this blog

The Patient health Information Service at Herzl (H-PHIS) opened its doors in early July of this year (2007) and is in the early developmental stages. The challenges faced by myself (the service's coordinator), the staff, and the health care team at the HFPC are many and varied, as is to be expected when implementing a new and innovative service.

Perhaps the most unique aspect of the InfoRx model is the presence and participation of the information professional/librarian at point of care. This new and multidisciplinary approach presents a distinctive challenge. Health and support staff are not always clear on what knowledge and skills a librarian brings to the team. Conversely, I must be able to recognize and adapt to the needs and character of the community and of the setting itself.

This blog was created in response to some very astute and constructive criticism. After presenting to the residents at their weekly rounds, I was approached by one of the partners at the clinic who suggested that rather than introducing myself and the service and then explaining how to use it, it would have been more effective to present some cases illustrating what the service has to offer to the residents and to their patients. I see this as a perfect example of the kind of disconnect that can happen when two very different professions come together. In essence I had presented the way I would have to my own professional colleagues, but this was not the most appropriate approach given my audience.

After giving it some thought it occurred to me that it could be useful, both for myself and the rest of the team, for me to present a weekly case here, and talk about some of the challenges we are faced with and how these might best be resolved. Hopefully this will introduce some transparency to the InfoRx process.

This is meant to serve as a record of, and forum for discussion about, our challenges and successes. It is hopefully also an opportunity for other information professionals to be inspired by one example of what can be accomplished outside of the library setting.

About Me

Francesca Frati has an MLIS from Dalhousie University and is the wearer of many interconnected professional hats. She works at the SMBD Jewish General Hospital Health Sciences Library (HSL) as Patient Information Specialist and Instruction Librarian, at the Herzl Family Practise Centre (HFPC) as Patient Information Coordinator, and in her spare (work) time provides research support for physicians.
Francesca is a member of the advisory committee for the Society of Teachers of Family Medicine (STFM) Conference on Practise Improvement: "Blueprint for the Medical Home".